Tricare Prime West referral waivers extended

May. 20, 2013 - 04:07PM
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Tricare Prime beneficiaries in the West region are still facing delays in obtaining specialty care, prompting Pentagon officials to extend the waiver period for getting treatment without a referral through June 18.

Regional contractor UnitedHealthcare Military & Veterans is still facing a backlog in processing specialty care referrals and authorizations, Tricare officials said Friday, and to avoid delays in patient care, the waiver period for Prime users — largely military family members and retirees — will be extended a month.

Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson announced May 2 that his office was taking “extraordinary measures” in waiving the authorizatioin requirements and penalty fees because UnitedHealth was “failing to meet contract requirements.”

Tricare spokesman Austin Camacho said on Monday the Defense Department won’t know how many beneficiaries have been affected by the backlog or are now facing delays until patients’ claims are processed.

He added, however, that the backlog has decreased since the waivers were announced.

“There has been significant progress,” Camacho said.

UnitedHealthcare officials said that after the company assumed management of the contract, “referral and care authorization volumes exceeded historical norms” and the company faced challenges processing them in a timely manner.

UnitedHealthcare Military & Veterans CEO Lori McDougal said they company is taking “aggressive actions” to fix the problems.

“We sincerely apologize for any delay in services that Tricare beneficiaries and care providers are experiencing,” McDougal said in a statement earlier this month.

According to Tricare, 1.7 million of the 2.9 million Tricare West region beneficiaries are enrolled in Prime. The region encompasses 21 states.

The waiver does not apply to those using Tricare Standard, Tricare for Life or the U.S. Family Health Plan.

UnitedHealthcare was awarded the Tricare West region contract, worth up to $21 billion over the next five years, in July 2012 after a prolonged contract award and protest process that began in 2009.

It began experiencing problems with call center volume and customer referrals nearly immediately after taking over the contract on April 1.